Linking social and built environmental factors to leisure-time physical activity in rural cancer survivors

Background: This study explored associations between social and built environmental factors and leisure-time physical activity (LTPA) in rural cancer survivors (RCS) and whether these associations differed by exercise stage of change (SOC). Method: RCS (n=219) completed questionnaires assessing LTPA, SOC, and social (social status, connectedness, support) and environmental (home environment, neighborhood environment) factors. Linear regression models examined associations between social and built environmental factors and LTPA and tested for moderation by SOC. Results: Half (50.7%) of RCS were physically active, and 49.3% were not active. Social factors positively associated with LTPA included subjective social status in the community (B=89.0, P=.014) and in the United States (B=181.3, P<.001), social connectedness (B=122.3, P=.024), and social support for physical activity from family (B=41.9, P<.001) and friends (B=44.3, P<.001). Environmental factors positively associated with LTPA included the home environment (B=111.2, P<.001), perceived environmental support for PA (B=355.4, P=.004), and neighborhood attributes, including bicycling infrastructure (B=191.3, P=.003), proximity to recreation facilities (B=140.1, P=.021), traffic safety (B=184.5, P=.025), and aesthetics (B=342.6, P<.001). SOC statistically significantly moderated the association between social status in the United States and LTPA (B=160.3, P=.031). Conclusions: Social and built environmental factors were consistently linked with LTPA and provide context for multilevel interventions promoting LTPA in RCS.